Welcome to the Great Wall China Adoption/Children of All Nations payment processing form. This form allows for simple transactions via credit card/debit card via our secure site to make donations to our charitable programs and for families contracted with our agency to conveniently make payments for contracted services. This form accepts Visa, Mastercard, and Discover. You can also use your personal debit card with the Visa or Mastercard logo--please make sure you've placed sufficient funds into that account before you make your payment! If you have any questions regarding payments you are making, please contact our business office during regular business hours at 512-323-9595.
 
Your Information
Adoption fees and services
Amount: $
Donation For:
Donation Amount:
If you selected other, please specify the amount below.
Other Amount: $
minimum donation of $25
Send donation letter for tax purposes:
*Full Name:
In Honor of:
*Address:
Your Phone Number:
*E-Mail Address:

Billing Information
*Driver License #:
*Driver License State:
*Name as shown on your card:
*Select the card you are using:
*Card Number: - - -
*Expiration Date:  
*Credit Card Validation       Number (CCV):
*Cardholder's Signature:
*Billing Street:
*Billing City:
*Billing State:
*Billing Zip Code:
*Billing Phone Number: - -

By signing my name below I agree that any adoption fee(s) paid to Great Wall China Adoption DBA, Children of All Nations, as indicated above, is nonrefundable. I verify that by signing the above credit card authorization form, I choose to pay by credit card for all services listed above and agree to all terms and conditions stated within the accompanying signed Agreement(s) or form(s). I acknowledge and understand, should I choose to stop my adoption at anytime during the process, all fees rendered on the above form are non-refundable.

* denotes required field